Paediatric sudden death

Sudden death in children and adults differs in many ways. Some of these differences are: anatomical and physiological differences in the premorbid state, aetiology of the sudden death and the associated cardiac rhythm, chest compression technique, problems with vascular access, and the scientific data on which recommendations are based. Most paediatric cardiac arrests are secondary to profound hypoxia or asphyxia due to respiratory failure or circulatory shock. Prompt rescue breathing and chest compressions are the treatments of choice for asphyxial cardiac arrest. However, early in the asphyxial process, either rescue breathing alone or chest compressions alone is better than nothing. The frequency of ventricular fibrillation (VF) in children has been underestimated. Early electrocardiographical diagnosis and early defibrillation is the optimal approach. Adjunctive therapies for shock-resistant VF include maximizing coronary perfusion with intravenous epinephrine and anti-arrhythmic therapy with intravenous amiodarone. Many avenues of investigation deserve exploration to improve the dismal outcome from paediatric sudden death.